Getting Pumped for State Healthcare Programs - Medicaid and Exhanges

1. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Getting Pumped for State Programs: Medicaid/Exchange

2. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 TODAYS QUEST PANEL Darren Huff Regional Sales Director East Region [email protected] Linda Borths Director of Sales [email protected] John Weis President & Co-Founder [email protected] Robert Smith Regional Sales Director West Region [email protected] 3. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 BUILT with VISION QUEST ANALYTICS SUITE The industry's only software solution that has continued to evolve to meet the changing demands of Network Adequacy. The Quest Analytics Suite fully integrates; Access, Disruption, Network Adequacy (Medicare and Custom), Address-level Geocoding and Hospital Quality Analysis into one easy to use suite. ACCESS ANALYSIS Access Analysis Access Comparison Mapping ADEQUACY ANALYSIS Medicare Advantage Medicaid Dual Eligibles Exchanges Commercial RFPs GEOCODER & DATA STANDARDIZATION Address-Level Accuracy Data Standardization Zip Correction True County Assignment DISRUPTION ANALYSIS Transparency & Confidence Provider Change Analysis QUALITY ANALYSIS Hospital Quality Tiered Networks 4. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 National Marketplace Presence 5. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Its Not IfIts When! 6. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Access VS. Adequacy CMS Revamps the process to: 1. Address geographic disparities across any state 2. Prevent adverse selection 3. Provide transparency of requirements 4. Apply consistency across plans 5. Leverage across programs 7. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Network Adequacy for Medicaid 8. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 FLORIDA Medicaid Requirements 9. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Medicaid Requirements This is where it turns Access to Adequacy! 10. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 MedicaidTemplates No Data Does Not Meet the Access Requirements 11. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 MedicaidTemplates Pick your Service Area Pick Your Provider Group Once Publicized, the Templates will be available to license here! Print/Export Your Reports 12. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Network Adequacy for State Based Exchanges 13. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 State Partnership + We are proud to have earned the business of the DMHC. The DMHC has integrated the Quest Analytics Suite for automating their process for Qualifying Health Plans for various government programs. 14. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Exchange Requirements {Nevada} Compliance with the distance standards will be achieved if 95 percent of the population of the geographic service area or existing HMO membership is within the distance standards of the providers with whom the Carrier contracts. The minimum distance standards for PPO insureds will be achieved if 50 percent of the population of the geographic service area or the Carriers enrolled membership is within the distance standards of the providers with whom the Carrier contracts. Specialty Urban Rural Frontier Ratio Time Distance Time Distance Time Distance Adult PCP 2500 45 45 60 60 100 120 OBGYN 2500 45 45 60 60 100 120 Pediatrics 2500 45 45 60 60 100 120 Urgent Care 5000 45 45 60 60 100 120 Emergency Medicine 5000 30 30 60 60 75 90 Mental Health 30000 30 30 60 60 90 90 Substance Abuse 30000 30 30 60 60 90 90 Cardiology 7500 60 60 90 90 180 180 Dermatology 17500 60 60 90 90 180 180 Gastroenterology 25000 60 60 90 90 180 180 Hematology/Oncology 17500 60 60 90 90 180 180 Nephrology 10000 60 60 90 90 180 180 Ophthalmology 27500 60 60 90 90 180 180 Orthopedics 10000 60 60 90 90 180 180 Otolaryngolgoy 25000 60 60 90 90 180 180 Pulmonology 20000 60 60 90 90 180 180 Surgery 12500 60 60 90 90 180 180 Urology 25000 60 60 90 90 180 180 *Essential Community Hospitals 60 60 90 90 180 180 15. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 ExchangeTemplates 16. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Medicaid & Exchange Templates 17. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Medicaid & Exchange Templates 18. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Essential Community Providers Minnesota Statutes, section 62Q.19 requires all health plans to offer contracts to state designated essential community providers within their service areas. 19. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 What if Network Adequacy Standards are not met? 20. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 CMS Exception Request LIST THE CONTRACTED PROVIDERS/FACILITIES THAT WILL ENSURE ACCESS (THEY MUST BE LISTED IN THE HSD TABLE UNDER THE COUNTY THEYRE PROVIDING SERVICES TO). ALSO, LIST THE CLOSEST CONTRACTED PROVIDER/FACILITY OF THE SPECIALTY CODE TYPE. NAME FROM HSD TABLE: PROVIDER NPI: SPECIALTY TYPE: ADDRESS (street, city, state, zip code, and telephone number): DISTANCE FROM MEDICARE BENEFICIARIES IN THE COUNTY: NAME FROM HSD TABLE: PROVIDER NPI: SPECIALTY TYPE: ADDRESS (street, city, state, zip code, and telephone number): DISTANCE FROM MEDICARE BENEFICIARIES IN THE COUNTY: NAME FROM HSD TABLE: PROVIDER NPI: SPECIALTY TYPE: ADDRESS (street, city, state, zip code, and telephone number): DISTANCE FROM MEDICARE BENEFICIARIES IN THE COUNTY: 21. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Maximum Distance greatest travel distance? 22. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 How far does someone have to travel to receive care? Some States May Ask For The Maximum Distance/Time That a Member Will Have to Travel Outside the Requirements! 23. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Network Adequacy for FFM 24. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 New Partnership 25. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Data CollectionTodaywith more to follow 26. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Data CollectionTodaywith more to follow CCIIO Network Adequacy Data Template National Provider Number (NPI)* First Name of Provider* Last Name of Provider* Physician / Non- Physician* Specialty Type (area of medicine)* Street Address* City* State* County* Zip* Network IDs* 27. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Competitive Positioning Giving you an apples-to-apples comparison of your data in One Application! 28. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Providers that Fit: Narrow Networks Strategies and Design 29. PROVIDING POWERFUL SOLUTIONS I Since 2003 I www.QuestAnalytics.com I 920.739.4552 I 2014 Thank you very much! Darren Huff Regional Sales Director East Region [email protected] Linda Borths Director of Sales [email protected] John Weis President & Co-Founder [email protected] Robert Smith Regional Sales Director West Region [email protected]